Research
Maternal psychosocial well-being in Eritrea: application
of participatory methods and tools of investigation and
analysis in complex emergency settings
Astier M. Almedom,1 Berhe Tesfamichael,2 Abdu Yacob,3 Zaı̈d Debretsion,4 Kidane Teklehaimanot,5
Teshome Beyene,6 Kira Kuhn,6 & Zemui Alemu7
Objective To establish the context in which maternal psychosocial well-being is understood in war-affected settings in Eritrea.
Method Pretested and validated participatory methods and tools of investigation and analysis were employed to allow participants to
engage in processes of qualitative data collection, on-site analysis, and interpretation.
Findings Maternal psychosocial well-being in Eritrea is maintained primarily by traditional systems of social support that are mostly
outside the domain of statutory primary care. Traditional birth attendants provide a vital link between the two. Formal training and
regular supplies of sterile delivery kits appear to be worthwhile options for health policy and practice in the face of the post-conflict
challenges of ruined infrastructure and an overstretched and/or ill-mannered workforce in the maternity health service.
Conclusion Methodological advances in health research and the dearth of data on maternal psychosocial well-being in complex
emergency settings call for scholars and practitioners to collaborate in creative searches for sound evidence on which to base maternity,
mental health and social care policy and practice. Participatory methods facilitate the meaningful engagement of key stakeholders and
enhance data quality, reliability and usability.
Keywords Maternal welfare/psychology; Mothers/psychology; Mental health; Anxiety; War; Emergencies; Mental health services;
Social support; Eritrea (source: MeSH, NLM ).
Mots clés Protection maternelle/psychologie; Mère/psychologie; Santé mentale; Angoisse; Guerre; Urgences; Service santé mentale;
Soutien social; Erythrée (source: MeSH, INSERM ).
Palabras clave Bienestar materno/psicologı́a; Madres/psicologı́a; Salud mental; Ansiedad; Guerra; Urgencias médicas; Servicios de
salud mental; Apoyo social; Eritrea (fuente: DeCS, BIREME ).
Bulletin of the World Health Organization 2003;81:360-366.
Voir page 364 le résumé en français. En la página 365 figura un resumen en español.
Introduction
There has recently been a growth of interest in mental health
research, particularly in relation to the improvement of policy
and practice across sectors (1–4). Most studies have involved
descriptive data on mental disorders at the population level and
have used large-scale survey methods, notably in work on the
global burden of disease and disability-adjusted life years (5).
Policy and practice in the field of mental health have
traditionally been based on evidence obtained from such
disease-centred studies. There is, however, growing interest in
person-centred approaches to mental health policy, particularly
in connection with such factors as stigma and social exclusion
(6, 7). Interdisciplinary salutogenic (as opposed to pathogenic)
perspectives on human ecology, coping mechanisms, strate-
gies of adaptation, stress management and resilience have
become increasingly relevant (8, 9).
Mental health studies in settings of complex humanitarian emergency fall into either the category of epidemiological
psychiatry (10) or that of psychosocial psychiatry, often
incorporating anthropology and/or sociology (11, 12). The
present study focuses on the psychosocial well-being of
women during pregnancy, childbirth, and the postpartum
period in complex emergency settings in Eritrea associated
with the 1998–2000 war with Ethiopia. Women, especially
mothers of infants and young children, bear the brunt of
economic, social, cultural and health burdens in societies
affected by war. Moreover, the morale and mental well-being
of mothers are important determinants of infant health in
wartime (13). Consequently, this study is also of relevance to
1
Henry R. Luce Professor in Science and Humanitarianism, Department of Biology and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
(email: astier-m.almedom@tufts.edu). Correspondence should be addressed to this author.
2
Participatory Trainer/Facilitator and Social Animator, Water Resources Department, Ministry of Environment, Water and Land, Asmara, Eritrea.
3
Sanitarian and Participatory Trainer/Facilitator, Ministry of Health, Barentu, Eritrea.
4
Senior Researcher and Financial Administrator, Eritrean Relief and Refugee Commission, Keren, Eritrea.
5
Nutrition Unit, Ministry of Health, Asmara, Eritrea.
6
Field Intern, Ministry of Health, Asmara, Eritrea.
7
Director, Primary Health Care Division, Ministry of Health, Asmara, Eritrea.
Ref. No. 02-0327
360
Bulletin of the World Health Organization 2003, 81 (5)
Maternal psychosocial well-being in Eritrea in complex emergency settings
infant and child health policy and practice in complex
emergency settings.
Eritrea has a population of about 4 million and has
frontiers with Djibouti, Ethiopia, and the Sudan. In the
highlands, staple crops and cash crops are grown (taff, wheat,
barley, maize and, in the green belt of Semenawi Bahri, coffee)
and there is dairy farming and goat, sheep, and poultry
production. In the lowlands and middle altitudes, agropastoralism and transhumance are practised. There are nine
ethnic groups with marked linguistic and sociocultural
differences: predominantly Tigrinya-speaking orthodox Christians in the highlands; mostly Moslem societies consisting of
Afar, Bilein, Hidareb, Nara, Rashaida, Saho and Tigre, ethnic
groups in mid-altitude and lowland areas; along with Kunama
Christians and followers of traditional religion.
The following questions are considered in this paper:
What are the local perceptions of available statutory and nonstatutory health services? What factors are believed to mitigate
the effects of war-induced anxiety and mental distress? How
do women and men differ in their perceptions of mental wellbeing?
Methods
Fieldwork was conducted in December 2001 and January,
August and September 2002 in seven locations of Eritrea
selected to include a range of geoclimatic zones and modes of
subsistence (Table 1). The western lowland and mid-altitude
provinces of Zoba Anseba and Zoba Gash-Barka and the
southern highland provinces of Zoba Debub were the areas
worst affected by the war because of their proximity to the
Ethiopian border. Word-of-mouth invitations resulted in the
recruitment of 104 women and 124 men to the study. All the
ethnic groups except the Afar and Rashaida were represented.
Participatory methods and tools of investigation and onsite analysis were employed. They had been extensively fieldtested, evaluated and validated in various countries, including
Eritrea (14, 15). The study team carefully questioned and
listened to the participants and kept written records. The
quality and reliability of the data were established as follows:
feedback sessions held at each study site in order to allow the
participants to review and interpret, and, if necessary, correct
the findings, and to enable the study team to follow up
incomplete data; checks on the accuracy of factual or objective
(as opposed to subjective) data relating to historical events,
involving the use of published material where available and
other secondary sources; and data triangulation by methods
and sources.
The study was designed in collaboration with the
Ministry of Health, with the fieldwork being conducted in
accordance with established ethical protocols and procedures
for the participatory research methods and tools used (14). The
guidelines of the Institutional Review Body of Tufts University
were observed. No incentives were offered and no obligations
were imposed on the participants. The purpose of the study
and all the group activities were explained in the local language
or languages by trained and qualified facilitators at the
beginning of each meeting. Any topic that the participants
were unwilling to discuss was set aside. Women’s and men’s
discussion groups were held in separate locations. All meetings
began and were brought to a formal closure by the facilitators.
For reasons unrelated to the conduct of the study, two
Bulletin of the World Health Organization 2003, 81 (5)
participants left before their discussion groups were scheduled
to end.
Results
Community maps and historylines were most appreciated by
study participants who saw these as useful records of local
knowledge that had not previously been sought and/or
recognized. Striking differences emerged between urban or
semiurban settings where little or no displacement had
occurred and camps for internally displaced persons in respect
of the amount of detail in community maps, seasonal calendars
and historylines.
Quality and effectiveness of available health services
The participants emphasized the inadequacy of health services
in general and of maternity services in particular at all sites
except Ghinda (Table 2). They indicated that it was urgently
necessary to have emergency transportation services for
women in labour, to provide training and a regular supply of
sterile delivery kits for traditional birth attendants, and to
improve the attitudes and behaviour of health workers.
Childbirth continued to take place mostly in people’s
homes with the help of traditional birth attendants. In cases of
protracted labour, loss of blood and/or delayed expulsion of
the placenta, the traditional birth attendants referred their
patients and often accompanied them to the nearest medical
facility. Fatalities occurred because of the limited availability of
transport and ambulance services. By the time a weak, anaemic,
and haemorrhaging pregnant woman arrived at a hospital she
might already be in shock or coma. The highest estimates of
maternal mortality, up to two or three deaths in a particular
month, were reported in Gogne, where most women were said
to be anaemic during pregnancy and weak during childbirth.
Health service provision in camps for internally
displaced persons was generally limited. In the Adi Qeshi
camp, which had existed for 3 years, mobile clinics had come
and gone at different times and were mostly limited to
immunization and nutritional surveillance of under-5-yearolds. Women reported that most of their infants and young
children were malnourished because of inadequate rations and
delayed weaning. In Hamboka and Awle’a Hahale, most of the
residents had been displaced more than once before arriving in
the Sen’afe area. Both men and women reported that they had
received a better quality of health care in a previous camp at
Mai Habar, a lowland, heavily malarial location farther away
from the war zone, where a Catholic mission had provided
mobile clinics. Their nearest hospital at Sen’afe had been
destroyed: all that remained was a row of large tents that had
been left behind by Médecins sans Frontières doctors soon
after the bombing and shelling had stopped. The participants
said that very long waiting times and rude health workers were
experienced in the tent hospital. As an example of what this
actually meant, it was reported that a young boy became ill after
queuing all night in the cold on behalf of his sick grandmother
who had to be seen by a doctor. Sen’afe lies over 2500 m above
sea level and cases of upper respiratory infections are common.
With the exception of Ghinda Hospital, where nurses
and doctors were said to have good relations with patients and
traditional birth attendants, the behaviour of health workers
was reportedly unacceptable. In Elaberid, the worst example,
nurse midwives reportedly treated their patients harshly,
361
Research
Table 1. Details of study sites and participantsa
Study site
Participants
Adi Qeshi (a lowland camp for internally displaced persons).
Located between Barentu (a small city) and Gogne (a small town) in Zoba Gash Barka, continuing to be administered as
sub-Zoba Lalai Gash. Almost entirely Tigrinya Christian Orthodox residents.
21 women
35 men
Awle’a Hahyle (a highland camp for internally displaced persons).
Located on the outskirts of Sena’fe (a large town) in Zoba Debub. Almost entirely Saho Muslim residents.
15 women
16 men
Elaberid (a small mid-altitude town), Zoba Anseba.
Located on the main road between Asmara (the capital) and Keren (a small town). A diverse population comprising Bilein,
Tigre, Tigrinya and other ethnic groups. Christians and Muslims.
19 women
14 men
Ghinda (a large mid-altitude town), Zoba Semenawi Qeyih Bahri.
Located on the main road between Asmara and Massawa (a major port city). A diverse population comprising Tigre, Saho,
Bilein, Tigrinya and other ethnic groups. Christians and Muslims.
16 women
7 men
Gogne (a small lowland town), Zoba Gash Barka.
Located between Barentu (a large town) and Tessenei (a large town). A diverse population comprising Kunama, Nara,
Tigre, Hidareb and other ethnicities. Christians and Muslims.
8 women
11 men
Hamboka (a highland camp for internally displaced persons), Zoba Debub.
Located on the main road between Sena’fe and Zalambessa. Residents almost all Tigrinya Christians.
13 women
28 men
Shi’eb (a small lowland town), Zoba Debubawi Qeyih Bahri.
Located on the main road between Af’abet (a large town) and Massawa. A predominantly Muslim population including
members of the Tigre, Saho and Rashaida ethnic groups.
12 women
13 men
a
There were no Rashaida or Afar participants in the group discussions.
routinely saying to women in labour ‘‘So you expect to have a
baby without pain, do you?’’. In contrast, traditional birth
attendants were reported to have commendable skills with
pregnant and newly-delivered mothers but they were not duly
recognized by the formal health care system. The Ministry of
Health training programme for traditional birth attendants was
perceived to be good. Most trained traditional birth attendants
continued to have a good rapport with their clients but they
lacked material support from the ministry. At Elaberid and
Ghinda the question of cash payment for trained traditional
birth attendants was debated in women’s discussion groups.
Some of the traditional birth attendants present found the idea
of cash payment problematic because it undermined the
humanitarian and prestigious role that earned them trust and
respect in their communities. Others did not object to cash
payment and said that nakfa 20–40 (less than US$ 4) per
delivery was too little. All traditional birth attendants
emphasized the need for formal training and regular supplies
of sterile delivery kits.
Factors mitigating the effects of war-induced
anxiety and distress
At the micro level, the factors that were believed to mitigate
mental ill-health in women included protective traditional
practices during pregnancy and childbirth. It was said that,
even in normal times, pregnancy and childbirth were associated
with anxiety and mental distress in women. For this reason
most Eritrean women are traditionally provided with special
care and support during pregnancy, childbirth, and beyond.
Most ethnic groups still uphold the tradition of postpartum
seclusion and rest for mothers who have just given birth. At
this time, mothers are exempted from any work other than
breastfeeding, and their families and friends help with
domestic tasks and ensure that they eat and rest well. Among
the Tigrinya highlanders and other Christians this period may
362
last for 40–80 days, while among Muslims a period of up to
6 months or even longer is allowed.
The war limited women’s ability to enjoy postpartum
seclusion and rest. The absence of husbands, brothers and
brothers-in-law and the associated loss of material, moral and
emotional support added to the burdens of expectant and
lactating women. Women emphasized the value of social
support from family, friends and confidantes, including
traditional birth attendants. Nevertheless, even during and
after the war, most people were said to be in good mental
health and cases of severe mental illness were rare, even among
mothers who had just given birth.
Women in Gogne concluded that the best ‘‘maternity
leave’’ practices were those of the Hidareb ethic group. A
Hidareb man takes full responsibility for the care of his wife
and new baby during the first 5–6 months postpartum, making
provision for his mother-in-law to live in the family home and
look after her daughter and new grandchild. If his wife and
baby fail to thrive he dismisses his mother-in-law and brings in
a substitute carer. Such dismissals were believed to have little or
no social consequences, because a mother-in-law who failed to
feed and care for her own daughter would expect to leave and
spare her son-in-law the shame and ridicule he would otherwise
have to endure in the community.
Women in the Adi Qeshi and Hamboka camps reported
that traditional postpartum seclusion and rest were no longer
possible because of lack of resources. The case of a young
mother, who had been mentally ill during her pregnancy and
had deteriorated after delivery, was discussed in Hamboka.
This woman could not breastfeed and care for her baby, which
was therefore fed on goat’s milk by relatives. The woman was
taken to stay with her mother, who lived in another village.
Women in Gogne and Ghinda mentioned rare but similar cases
of maternal mental illness before and after childbirth. They
believed the causes to be unwanted pregnancy and lack of
Bulletin of the World Health Organization 2003, 81 (5)
Maternal psychosocial well-being in Eritrea in complex emergency settings
Table 2. Availability, quality, and effectiveness of maternal health services in the study sites
Site
Statutory services
Non-statutory services
General
Maternity/maternal and child health
Traditional birth
attendants
Adi Qeshi
Successful distribution
of bednets (malaria
programme)
Intermittent mobile clinics (outreach
programme); nutritional surveillance
tent
Yes; some trained
None or limited
Awle’a Hahyle
Very limited or none
Very limited or none
Practice dying out
Not mentioned
Elaberid
Health centre.
Mismanaged distribution
of bednets (malaria
programme)
Yes; some trained but
Limited (childbirth referrals go to Keren
lacking equipment and
hospital). Women discouraged by health
workers’ bad behaviour and by perceived recognition
high maternal mortality rates in the hospital
None
Ghinda
Health centre,
hospital and clinic
Excellent. Positive and caring attitude
and behaviour of health workers
Not mentioned
Gogne
Almost none; one clinic
with very limited human
and material resources
None. Two or three women may die in
Yes; some trained but
childbirth in one month; miscarriages and
lacking in equipment
stillbirths increase during the malaria season
None or limited
Hamboka
Very limited or none
Very limited or none
Yes; some trained
Limited
Shi’eb
Limited
Limited
None
Not mentioned
social support, particularly among young and unmarried
women. A mother’s inability to relate to her infant and failure
to breastfeed and care for it were the most commonly
identified indicators of maternal mental illness.
At the macro level the most important protective factor
for internally displaced persons in camps was reported to be
statutory social support in the form of assisted relocation. A
special effort was made to allow village units to remain together
even after displacement. For example, people in the Adi Qeshi
camp, named after a cluster of evacuated villages, reported that
much of their anxiety was alleviated by the manner in which
their flight to safety was facilitated. Lorries, buses and trucks
had been provided primarily for the vulnerable, i.e. pregnant
and nursing women, children, the sick and the elderly, while
able people had left their villages on foot when Ethiopian
attack was imminent. Villagers and their administrators and
leaders were taken to a camp equipped with tents, latrines,
water points and reservoirs. The administrators and leaders
were thus able to maintain contact with the people for whom
they were responsible, and the surviving men and women were
not required to prove their identities and family sizes to
officials or aid workers whom they did not know. The village
administrators worked closely with the Eritrean Relief and
Refugee Commission in order to expedite the distribution of
food and blankets and to facilitate the immunization of
children. This helped to maintain pre-existing social ties and
support networks. Moreover, people were kept informed
about events outside their camp through the national radio
station, Dimtsi Hafash, and through regular meetings convened
by the administrators. Most participants believed that a sense
of being in touch with their own community and the country as
a whole protected them from Chinquet (mental oppression),
Ĥasab (thinking too much) and Ihihta (sighing). However, some
expressed weariness about the length of time they had lived in
camps. In Adi Qeshi, women explained that even if the peace
agreement and border demarcation went smoothly they might
not be able to return to their homes until their villages were
cleared of land mines.
Bulletin of the World Health Organization 2003, 81 (5)
Yes; excellent collaboration
with hospital when needed
Nongovernmental
organizations
Gender and mental well-being
Overall, men and women were equally prepared to participate
in group discussions of mental well-being in general terms. In
the Adi Qeshi camp, women reported that previous visitors
had repeatedly asked many questions about violence and
trauma they might have experienced. Although many women
had suffered, most had coped reasonably well ‘‘thanks to Qidisti
Mariam’’ (Saint Mary), who ‘‘helps women during the difficult
periods of pregnancy and childbirth’’. As time passed, some
women had become frustrated about their prolonged
dependence on hand-outs and food aid and the loss of Qisanet
(serenity, peace of mind). These women preferred not to
discuss the matter further.
Marked differences were found between men’s and
women’s reported psychosocial well-being in the community
and their priorities for action when peace returned. In Elaberid,
Ghinda and Gogne, men discussed the increasing prevalence
of restlessness during daytime and sleeplessness at night
caused by the prolonged conflict and uncertainty about the
prospects of lasting peace. In the Adi Qeshi camp, men
discussed their inability to come to terms with the loss of lives
and assets. They described overwhelming feelings of anger and
a desire to take revenge. In the Hamboka camp, men were
mainly concerned about their reputations. They believed that
they were being blamed for starting the war by failing to resolve
disputes with neighbours on the other side of the border.
Discussion
A sociocultural basis for research and humanitarian interventions has recently been advocated in order to bring about
psychosocial well-being among the survivors of disasters (9,
11, 16). WHO supports the view that preconceived and/or
crude notions of mass trauma (as manifested by post-traumatic
stress disorder) and social dysfunction should not drive
humanitarian action (18, 19). Nongovernmental organizations
such as the Save the Children Fund have also advocated
caution in this matter (20). Nevertheless, it remains rare for
363
Research
psychosocial projects to be based on assessments of local
sociocultural contexts and/or expressed needs. Many needs
assessment exercises concentrate on requirements for what
funding and operational agencies have to offer rather than on
needs articulated by victims (17, 18). The present study has set
out to demonstrate that understanding the context and
expressed needs and priorities of survivors of complex
emergencies is both essential and achievable.
The situation in Eritrea does not precisely fit the
conventional definition of a complex humanitarian emergency.
This term was coined to distinguish so-called natural disasters
from those caused by political turmoil, conflict and war (21).
However, most if not all disasters are complex, be they natural
or man-made. Eritrea has experienced both kinds of disaster.
During the armed struggle for independence from 1961–91,
primary and secondary health care systems were developed
under complex and chronic emergency conditions in response
to pressing problems among both civilians, mostly in rural
areas, and members of the armed liberation movement. A
symbiotic relationship existed between the civilian and armed
groups. The civilians depended on the armed groups for
material social support, including health care provision, while
the armed groups depended on the civilians for moral support,
protection and emotional social support. Both relied on mutual
and timely social support of the cognitive type (22). There is
much evidence of individual and collective resilience and
resourcefulness in the face of war and calamity (23, 24).
However, this does not mean that people who succumb to
mental illness should be overlooked. The mental well-being
and morale of mothers with infants and young children should
be attended to, as women bear the burden of responsibility of
maintaining their families, bringing up future citizens and
preserving the social fabric, health and well-being of their
communities in emergency conditions (13).
The health and mental well-being of mothers and infants
are protected and promoted at the micro level by social support
in the form of postpartum seclusion and rest for mothers, and
at the macro level by social support in the form of governmentassisted relocation. On the other hand, prolonged and multiple
or serial displacements present risk. Traditional birth attendants have a major role in the promotion of maternal mental
well-being. The formal recognition and integration of trained
traditional birth attendants in mainstream maternity services
may be viable and sustainable in post-conflict primary heath
care in Eritrea. The problem of harsh and ill-mannered health
workers is not unique to the settings described in this paper.
Other studies have found that nurse midwives may be abusive
to their patients for various reasons, ranging from professional
insecurity to a notion of patient inferiority (25). Such abuse
discourages women from seeking medical care during
pregnancy and childbirth (26). Traditional birth attendants
could conceivably be recruited to train nurse midwives in the
care of patients. Of course, many nurse midwives and other
health workers care for their patients with professional
integrity and compassion. Unfortunately, news of bad practice
travels quickly and may have a more lasting impact on
perceptions.
Concern over the quality and reliability of qualitative data
can safely be allayed. Participant checking and cross-checking
with other reliable sources have confirmed the accuracy of lay
people’s knowledge of their own social and political history and
geography. For example, the data from Gogne’s historyline
concur with published historical accounts of the ethnic
diversity, political allegiances and conflict in the region (27,
28). Women’s accounts of shortcomings in maternity health
services were corroborated by visiting the health facilities
mentioned and by reviewing independent sources (29).
Participatory qualitative research of the type described here
can evidently help to address the problems of unreliable and
unusable data relating to disasters (30). n
Acknowledgements
We thank the following: the participants, who gave generously
of their time and knowledge; Ayesha Sa’id and Sa’edia
Suleiman, interpreters of the Kunama and Saho languages,
respectively; Sister Kidisty Habte, Sister Azenegash Ghebresellasie and Dr Tesfaldet Teclemichael for helpful insights; and
two anonymous reviewers for constructive criticisms of an
earlier draft of this paper. The Eritrean Ministry of Health and
USAID/Technical Assistance and Support Cooperation
provided logistical assistance.
Funding: The study was funded by Tufts University Henry
R. Luce Professorship in Science and Humanitarianism.
Additional fieldwork was supported by the United States
Centers for Disease Control and Prevention, National Center
for Environmental Health, International Emergency and
Refugee Health Branch, Requisition No. IER08/01.
Conflicts of interest: None declared.
Résumé
Bien-être psychosocial maternel en Erythrée : application de méthodes et d’outils d’investigation
et d’analyse participatifs dans des situations d’urgence complexes
Objectif Définir comment est perçue la notion de bien-être
psychosocial maternel dans des environnements touchés par la
guerre en Erythrée.
Méthodes Des méthodes et des outils d’investigation et
d’analyse participatifs prétestés et validés ont été utilisés pour
permettre aux participants d’effectuer un travail de collecte de
données qualitatives, d’analyse sur le terrain et d’interprétation des
données.
Résultats En Erythrée, le bien-être psychosocial des mères est
assuré principalement par les systèmes traditionnels de protection
sociale qui se situent pour la plupart hors du champ des soins de
364
santé primaires institutionnalisés. Les accoucheuses traditionnelles
maintiennent un lien essentiel entre les deux systèmes. La
formation systématique de ces dernières et la fourniture régulière
de trousses d’accouchement stériles semblent être des options
valables, tant sur le plan de la politique de santé que sur le plan
pratique, face aux problèmes d’effondrement de l’infrastructure et
de surmenage et/ou de mauvais comportement du personnel des
services de maternité structurés faisant suite à un conflit.
Conclusion Compte tenu des progrès méthodologiques de la
recherche en santé et du manque la pénurie de données sur le bienêtre psychosocial maternel dans des situations d’urgence
Bulletin of the World Health Organization 2003, 81 (5)
Maternal psychosocial well-being in Eritrea in complex emergency settings
complexes, il serait utile que les chercheurs et les praticiens fassent
preuve de créativité et unissent leurs efforts pour rassembler des
données factuelles fiables sur lesquelles pourraient s’appuyer la
politique et la pratique en matière de santé maternelle, de santé
mentale et de protection sociale. Le recours à des méthodes
participatives facilite un véritable engagement des principaux
acteurs et permet d’améliorer la qualité, la fiabilité et la commodité
d’utilisation des données.
Resumen
El bienestar psicosocial materno en Eritrea: aplicación de métodos e instrumentos de investigación y
análisis de carácter participativo en entornos de emergencia complejos
Objetivo Establecer el contexto en que se interpreta el bienestar
psicosocial materno en los entornos afectados por conflictos
bélicos en Eritrea.
Métodos Se emplearon instrumentos de investigación y análisis y
métodos de carácter participativo, debidamente preensayados y
validados, para permitir a los participantes colaborar en los
procesos de recopilación de datos cualitativos, análisis in situ e
interpretación.
Resultados El bienestar psicosocial materno en Eritrea se
mantiene principalmente gracias a sistemas tradicionales de apoyo
social que en su mayorı́a no forman parte de la atención primaria
obligatoria. Las parteras tradicionales constituyen un eslabón
crucial entre esas dos esferas. La capacitación formal y el suministro
regular de kits estériles para partos parecen ser opciones válidas
para la polı́tica y práctica sanitarias ante los retos posconflicto que
suponen una infraestructura arruinada y una fuerza laboral
desbordada y/o poco delicada en los servicios de maternidad.
Conclusión Considerando los avances metodológicos de las
investigaciones sanitarias y la escasez de datos sobre el bienestar
psicosocial materno en los entornos de emergencia complejos, es
preciso que los especialistas y los profesionales colaboren para
buscar creativamente pruebas sólidas en las que basar la acción
normativa y práctica en los servicios de maternidad, salud mental y
atención social. Los métodos participativos ayudan a lograr un
compromiso provechoso por parte de interesados directos clave y
mejoran la calidad, fiabilidad y usabilidad de los datos.
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